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Story From Cayuga Medical Center: Robotic surgery brings a new advancement for orthopedic care

“Having this advanced technology will allow more patients in our community to stay right here for their knee replacements. Our orthopedic program has a record of excellence equal to or better than many large medical centers."

When Deidre Blake, MD, describes the new robotics-assisted knee surgery platform at Cayuga Medical Center, she stresses the words: accurate, precise, and customized. As an orthopedic surgeon and medical director of the Cayuga Center for Orthopedics, Dr. Blake knows the success of a knee joint replacement surgery literally hinges on millimeters and fractions of an angle’s degree. When implants are customized to the patient and placed with precision and accuracy, the patient will be able to walk without pain ­– often for the first time in years – and the prosthetic joint will have more than a 90 percent chance of lasting 10 or more years.

Dr. Blake is one of four board certified orthopedic surgeons now using the new NAVIO◊ Surgical System at Cayuga Medical Center. The technology brings an unparalleled level of accuracy and precision to partial and total knee replacement surgery that was more typically available at larger hospitals many miles away from Ithaca.

“Having this advanced technology will allow more patients in our community to stay right here for their knee replacements. Our orthopedic program has a record of excellence equal to or better than many large medical centers. Now we’re adding the latest joint-replacement technology to improve the care local patients can find close to home," says Dr. Blake, who led the effort to bring the NAVIO◊ system to Cayuga Medical Center. The technology was developed by Smith & Nephew, a leading global manufacturer of joint replacement systems.

While the term robotics-assisted knee surgery may prompt some to wonder how large of a role the robotic equipment has in the operating room, Dr. Blake emphasizes the surgeon is always in control. The NAVIO◊ system provides the surgeon with information to plan the procedure and delivers an extra margin of safety during surgery, but it is the surgeon who manages the procedure.

Planning the procedure

A knee replacement procedure begins well before any scalpel is used. For a successful procedure, the surgeon must understand how the complex web of ligaments, bones and muscles in a patient’s knee interact. That interplay affects the joint’s structural integrity, range of motion, and the pain a patient may feel when moving. Knowing the intricacies of the joint allows the surgeon to plan the surgery, and the NAVIO◊ system provides some unique features that help a surgeon develop a customized plan for each patient. The surgeon uses the NAVIO◊ technology to create a virtual map of the patient’s knee joint. The mapping is done without exposing the patient to potentially hazardous levels of radiation for a CT scan, or an expensive MRI, that are used with other robotic systems.

Starting the surgery

The surgery begins when a surgical nurse attaches tracking devices to the patient’s leg to monitor movement during the procedure. Next, the surgeon uses a hand-held instrument to gather information on the knee joint’s anatomy that is displayed with extraordinary detail on a video monitor. The mapping is dynamic, and the video image updates when the patient’s leg is moved to assess the joint from various angles and positions. The surgeon uses the mapping data to plan the surgery and conduct a virtual run-through before the actual procedure starts. When the surgery begins, NAVIO◊ provides real-time visual updates so the surgeon has a precise view of the procedure’s progress and can adjust the surgical plan if needed.

Placing the implant

After the virtual mapping is completed and reviewed for accuracy, the surgeon uses a semi-autonomous robotic tool with a cutting tip to prepare the joint for the implant. As the surgeon removes millimeter thicknesses of bone, the NAVIO◊ unit calculates the cutting tip’s exact location on the joint and displays it on the video monitor. The surgeon can freely move the hand-held tool, but the cutting action stops instantly if the tip moves outside the designated cutting space. The instant-response technology adds an extra margin of safety to the surgery. After the bone surface is prepared, the surgeon uses the NAVIO◊ system to assesses the location for the implant. Adjustments, if needed, are made before permanently placing the implant in the optimal position for the joint’s range of motion, balance and stability with surrounding soft tissues.

Ending years of joint pain

Joint replacement surgery often follows years of pain for a patient who has osteoarthritis, the most common form of arthritis. When patients push through their pain and continue using the knee joint, they may further damage and deform cartilage and bones making surgery their last best option for pain relief. The joint damage from osteoarthritis can occur in one or all of the knee joint’s three compartments – one on each side of the knee and one beneath the knee cap. If the joint damage is limited to one compartment, a partial knee replacement may be recommended because it preserves healthy bone and ligaments that stabilize the joint and replaces the damaged area with a prosthetic implant.

While the NAVIO◊ system is FDA approved for total and partial knee replacements, it was initially designed specifically for the more delicate partial procedure. Partial knee replacements are often less painful and heal more quickly than total replacements, and patients often walk more naturally after recovery. Cayuga Medical Center had traditionally performed few partial replacements because it lacked a robotics system, Dr. Blake says.

“NAVIO◊ changes that. We’ll do more partial joint replacement at Cayuga Medical because we have the surgical skills and now have the technology to do the procedure well,” she says.

The NAVIO◊ platform is transforming joint replacements procedures. As the benefits of robotics-assisted knee surgery are more widely appreciated by patients and surgeons, Dr. Blake expects the technology will be used more frequently than traditional joint replacements procedures.